Hepatitis C Virus Infection: Epidemiological, Diagnostic and Therapeutic Aspects at the Departmental and Teaching Hospital of Borgou-Alibori

Review Article

Austin J Infect Dis. 2023; 10(3): 1086.

Hepatitis C Virus Infection: Epidemiological, Diagnostic and Therapeutic Aspects at the Departmental and Teaching Hospital of Borgou-Alibori

Saké K¹*; Attinsounon CA¹; Kpossou AR²; Tobada ES¹; Fanou CD³; Ahanhanzo Glèlè R4; Kèkè KR4; Gbedo SE5; Savi de Tové K-M¹; Sèhonou J²; Kodjoh N2,5

1Department of Medicine and Medical Specialties, Faculty of Medicine, University of Parakou, Benin

2Department of Medicine and Medical Specialties, Faculty of Health Sciences, University of Abomey-Calavi, Benin

3Hepato-Gastro-Enterology Department, Army Training hospital - Teaching Hospital, Parakou, Benin

4Health Program to Fight AIDS, Benin

5National Hepatitis Control Program, Benin

*Corresponding author: Saké Khadidjatou Hepato-Gastroenterologist, Department of Medicine and Medical Specialties, Faculty of Medicine, University of Parakou, BP: 123 Parakou, Benin. Tel: 00229 65310564 Email: khadisak@yahoo.fr

Received: June 05, 2023 Accepted: June 26, 2023 Published: July 03, 2023

Abstract

Introduction: Hepatitis C Virus (HCV) infection is a global public health problem. The epidemiology of this condition in Parakou is still poorly understood. The aim of this study was to investigate the epidemiological, diagnostic and therapeutic aspects of hepatitis C virus infection in the internal medicine department of the Departmental and Teaching Hospital of Borgou-Alibori (DTH-B/A), Parakou.

Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection. It concerned patients received in hepato-gastroenterology consultation from 1st January, 2017 to 30 June, 2021. Patients who had undergone a minimal pre-therapeutic workup, which included testing for hepatitis C virus antibodies (anti-HCV Ac) and quantification of viral RNA by PCR, were included. The data were collected from each patient’s medical record and transcribed on a pre-established collection form. Analysis was performed using Epi Info software version 7.2.

Results: During the study period, 2786 patients were seen in hepato-gastroenterology consultations. Among them, 142 patients (5.1%) were HCV-positive. Of these seropositive patients, 73 (51.4%) met the inclusion criteria and were selected for the present study. The mean age was 45.5±14.7 years. Thirty-nine (53.4%) were male, for a sex ratio of 1.2. Forty-seven (64.4%) had progressive HCV infection with detectable RNA, including 3 (6.4%) at the stage of liver cirrhosis. Treatment was indicated in these 47 patients (64.4%) and was effective in 35 (74.5%). In all these patients, the HCV RNA test at the control PCR at least three months after the end of treatment was negative (undetectable RNA), representing a sustained virological response of 100%.

Conclusion: At DTH-B/A, HCV infection most often affects young adult males. Viremic forms are in the majority. Treatment with direct-acting antivirals remains highly effective.

Keywords: HCV; Epidemiology; Direct action antivirals; Parakou; Benin

Abbreviations: Anti-HCV Ac: Antibodies to Hepatitis C Virus; ALAT: Alanine Aminotransferases; APRI: Aspartate Aminotransferase to Platelet Ratio Index; RNA: Ribonucleic Acid; ASAT: Aspartate Aminotransferases; DTH-B/A: Departmental and Teaching Hospital of Borgou-Alibori; NTH-HKM: National and Teaching Hospital -Hubert Kutuku Maga; HCV: Hepatitis C Virus; HBV: Hepatitis B Virus; HIV: Human Immunodeficiency Virus; PCR: Polymerase Chain Reaction

Introduction

Hepatitis C Virus (HCV) infection is a global public health problem. In fact, according to the World Health Organization (WHO) in 2015, 71 million people were chronically infected with HCV [1]. In 2019, the WHO estimated that 1.5 million new HCV infections occur each year and that around 290,000 deaths per year are attributable to complications of chronic hepatitis C worldwide [2]. According to Markov model analysis, by 2030, 30% of deaths will be due to complications of HCV infection [3]. With the aim of reducing mortality from chronic viral hepatitis, in 2016 the World Health Assembly approved targets set by the WHO for the elimination of these conditions. These targets aim to reduce global incidence of Hepatitis B Virus (HBV) and HCV infection by 90% and mortality by 65% by 2030 [4].

In Benin, the national prevalence of HCV infection is unknown. Kodjoh et al [5] in a study carried out in 2013, noted a prevalence of 4.12% for HCV infection among new blood donors. Another study carried out in 2019 at the National and Teaching Hospital - Hubert Kutuku Maga (NTH-HKM) in Cotonou by Kpossou et al. [6] found a hospital frequency of 5.7% for HCV infection. The epidemiology of this condition is still poorly understood in Parakou, in the northern part of Benin . We felt it necessary to take stock of the epidemiological, diagnostic and therapeutic situation of patients carrying anti-HCV Ac in Parakou.

The aim of this study was to investigate the epidemiological, diagnostic and therapeutic aspects of HCV infection at DTH-B/A.

Patients and Methods

Type and Period of Study

This was a descriptive cross-sectional study with retrospective data collection taking into account patients seen in hepato-gastroenterology consultations from January 1st, 2017 to June 30th, 2021.

Study Framework

The study took place in the Internal Medicine Department of the Departmental and Teaching Hospital of Borgou -Alibori, Parakou.

Study Population

It is made up of all patients received and/or screened positive for antibodies to HCV (anti-HCV) and followed up in the department during the study period.

- Inclusion criteria

Those who were able to complete the minimum pre-therapeutic work-up: HCV RNA quantification, aminotransferase assay, prothrombin level, blood count and abdominal ultrasound, were included.

- Exclusion criteria

All patients with incomplete minimum workup, including failure to quantify HCV RNA, were excluded from the study.

Sampling

All patients meeting the inclusion criteria were recruited during the study period.

Variables

The dependent variable was anti-HCV Ac positivity. The independent variables concerned epidemiological, clinical, paraclinical, diagnostic, therapeutic and treatment-related data.

Data Collection

The medical records of patients who consulted the hepato-gastroenterology department of the DTH-B/A internal medicine service were used. The information collected was transcribed onto a specially designed form.

Diagnostic Criteria

Positive diagnosis of cirrhosis was non-invasive based on variable associations of the following clinical and paraclinical signs: Aspartate aminotransferase to Platelet Ratio Index (APRI) score greater than 2 [7]; liver changes on clinical examination and imaging (painless, hard, sharp lower border, granulated anterior surface hepatomegaly; hepatic dysmorphia on ultrasound); signs of portal hypertension (collateral venous circulation, splenomegaly, thrombocytopenia, dilatation of the portal trunk on ultrasound, oesophageal varices); signs of hepatocellular insufficiency (white fingernails, palmar erythrosis, gynecomastia, low prothrombin level, low albumin level)

In the present study, aminotransferases, prothrombin levels and blood counts were considered as standard biological parameters.

Performing Examinations

Clinical examination was performed by a hepato-gastroenterologist. HCV RNA quantification was performed by real-time PCR at Benin's national virology reference laboratory in Cotonou by a medical biologist. Abdominal ultrasound was performed by radiologists.

Data Processing and Analysis

Data were collected from patients' medical records. Analysis was performed using Epi Info version 7.2 software. Qualitative variables were expressed as numbers and percentages. The mean and standard deviation were used for quantitative variables.

Ethical Considerations

For this retrospective study, the data collected were processed anonymously and confidentially.

Results

During the study period (January 1st, 2017 to June 30th, 2021), 2786 patients were seen in hepato-gastroenterology consultations. Anti-HCV testing was positive in 142 patients. Of the latter group, only 73 (51.4%) were able to complete the minimum pre-therapeutic workup and were the subject of the present study.

Epidemiological Data

The mean age of included patients was 45.5±14.7 years, with extremes of 17 and 80 years. Patients aged 40 to 59 years were the most represented (33 or 45.2%). Of the 73 patients included, 39 (53.4%) were male, giving a sex ratio of 1.2.

In terms of socio-professional status, 6 patients (8.2%) were healthcare workers and 22 (30.1%) were employees in the public and private sectors.

Of the 73 HCV-positive patients, 12(16.4%) had a family history of HCV infection. Sixty-two (84.9%) had a history of scarification. Nine patients (12.3%) consumed alcoholic beverages. The mean quantity of alcohol consumed was 41.1±17.6 grams/day, with extremes of 20 and 60 grams/day.

Diagnostic Aspects

- Clinical data

The main circumstance of discovery was screening (38 patients or 52.1%), either during a campaign or a systematic check-up. Five patients (6.8%) tested positive for HCV during a blood donation. Twenty-nine patients (39.7%) had consulted their doctor less than a month after the discovery of positive HCV serology. The delay between first consultation and diagnosis was greater than 12 months in 26 patients (35.6%). Of the 73 HCV-positive subjects included, 54 (74%) were symptomatic. Asthenia was reported by 44 patients (60.3%), but the physical examination was normal in 63 patients (86.3%). Table I shows the distribution of patients according to clinical signs.

Citation: Saké K, Attinsounon CA, Kpossou AR, Tobada ES, Fanou CD, et al. Hepatitis C Virus Infection: Epidemiological, Diagnostic and Therapeutic Aspects at the Departmental and Teaching Hospital Of Borgou-Alibori. Austin J Infect Dis. 2023; 10(3): 1086.